Mental health peer support workers’ experiences and management of interpersonal boundaries: A scoping review and integrative framework

Peer support workers (PSWs) have been integrated in mental health services at an increasing rate, indicating strong recognition of the value they provide. Research has consistently shown that PSWs experience significant interpersonal boundary challenges in the course of their work, and that these boundaries manifest with service users and interprofessional mental health teams in which PSWs are embedded. The literature, however, is fragmented; it lacks clear definition of boundaries, does not clearly outline types of boundaries, and falls short of delineating boundary management approaches and tactics in a systematic way. Our review overcomes these limitations by categorizing, integrating and synthesizing research on interpersonal boundaries in PSW work. A scoping review was conducted in accordance with PRISMA-ScR reporting guidelines and JBI Manual for Evidence Synthesis methods. Studies focusing on formally employed mental health PSWs were retrieved by searching 5 scholarly databases. After screening, a total of 52 studies were identified that specifically address the issue of interpersonal boundaries. These studies were qualitatively synthesized using a thematic approach. We find that PSWs experience liminality in their relationships with service users and interprofessional mental health team members, that boundary challenges are often experienced as persistent tensions, and that managing these tensions has various consequences that depend on specific contextual factors. Our review presents an integrative framework that brings together boundary types, overarching boundary management approaches, and specific boundary management tactics to inform and guide future research. It also offers a foundation for deeper reflection on practices surrounding peer support work.